Forearm, Wrist, and Hand Evaluation

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Forearm, Wrist, and Hand Evaluation
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Overview

• Applied anatomy
• Common wrist and hand injuries
• History
• Observation
• Examination
• AROM/PROM
• Special tests
• Neurological exam
• Circulatory exam

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Bony Anatomy

• 29 total bones (27 not counting radius and ulna)
• 8 carpals
• 5 metacarpals
• 14 phalanges
• Radius
• Ulna

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Bony Anatomy

• Carpals
• Navicular
• Lunate
• Triquetrum
• Pisiform
• Trapezium
• Trapezoid
• Capitate
• Hamate

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Bony Anatomy

• Handy memory tricks
• Never Lie To a Preacher, The Truth Comes Home
• New Lovers Try Positions That They Cant Handle

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Bony Anatomy

• Metacarpals
• 1-5
• Thumb is 1, pinky is 5
• Phalanges
• Proximal, intermediate, distal

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Bony Anatomy

• Radius ulna
• Styloid processes

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Bony Articulations

• DRUJ
• Radiocarpal (wrist)
• Condyloid-type
• Flexion, extension, abduction, adduction

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Bony Articulations

• Thumb
• Ginglymus
• Saddle joint of CMC
• Digits 2-5
• 3 condyloid joints
• Interphalangeal (IP) Proximal interphalangeal
  (PIP) Distal interphalangeal (DIP)

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Articulations

• Joints
• MCP (metacarpophalangeal)
• PIP (proximal interphalangeal)
• DIP (distal interphalangeal)

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Articulations

• The thumb is different!!
• Joints
• MCP (metacarpophalangeal)
• IP (interphalangeal)

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Muscular Anatomy

• Flexor group (anterior)
• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus
• Flexor digitorum superficialis
• Flexor digitorum profundus
• Flexor pollicis longus

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Muscular Anatomy

• Extensor group (posterior)
• Extensor carpi radialis
• Extensor carpi ulnaris
• Extensor digitorum
• Extensor pollicis longus brevis
• Abductor pollicis longus

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Muscular Anatomy

• Flexor group (anterior)
• Flexor carpi radialis
• Flexor carpi ulnaris
• Palmaris longus
• Flexor digitorum superficialis
• Flexor digitorum profundus
• Flexor pollicis longus

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Flexor Group

• Flexor Carpi Radialis (FCR)
• O medial epicondyle
• I palmar hand
• A flexion, abduction
• N median

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Flexor Group

• Flexor Carpi Ulnaris (FCU)
• O medial epicondyle
• I palmar hand
• A flexion, adduction
• N ulnar

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Flexor Group

• Palmaris Longus
• O Medial epicondyle
• I palmar hand
• A flexion
• N Median

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Flexor Group

• Flexor Digitorum Superficialis
• O medial epicondyle, proximal radius ulna
• I middle phalanx of digits 2-5 (palmar surface)
• A finger wrist flexion
• N median

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Flexor Group

• Flexor Digitorum Profundus
• O proximal ulna
• I distal phalanx of digits 2-5 (palmar surface)
• A finger wrist flexion
• N median

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Finger Flexors
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Flexor Group

• Flexor Pollicis Longus
• O proximal radius ulna
• I distal phalanx of digit 1 (thumb) (palmar
  surface)
• A thumb wrist flexion
• N Median

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Extensor Group

• Extensor Carpi Radialis (ECR)
• O lateral epicondyle
• I dorsal hand
• A ext abd
• N radial

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Extensor Group

• Extensor Carpi Ulnaris (ECU)
• O lateral epicondyle
• I dorsal hand
• A ext add
• N radial

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Extensor Group

• Extensor Digitorum
• O lateral epicondyle
• I middle distal phalanges of digits 2-5
  (dorsal hand)
• A finger wrist ext
• N radial

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Extensor Group

• Extensor Pollicis Longus Brevis
• O posterior distal radius ulna
• I proximal distal phalange of digit 1
  (thumb)(dorsal hand)
• A thumb wrist ext
• N radial

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Extensor Group

• Abductor Pollicis
• O posterior distal radius ulna
• I first metacarpal (dorsal hand)
• A thumb wrist abd
• N radial

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Carpal Tunnel

• Transverse carpal ligament
• Median nerve
• Flexor digitorum profundus (4)
• Flexor digitorum superficialis (4)
• Flexor pollicis longus

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Common Forearm, Wrist Hand Injuries

• Contusions
• Forearm splints
• Colles fracture
• Distal radius ulna fracture

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Common Forearm, Wrist Hand Injuries

• Wrist sprain
• Carpal tunnel syndrome
• Tenosynovitis
• Tendinitis

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Common Forearm, Wrist Hand Injuries

• De Quervains disease
• Scaphoid fracture
• Pain in the anatomical snuffbox
• Early diagnosis essential in proper treatment
• Wrist ganglion

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Common Forearm, Wrist Hand Injuries

• Contusion to hand and fingers
• Mallet finger
• Torn extensor tendon (ED) at DIP
• Splint in extension 6-8 weeks
• Boutonniere deformity
• Torn extensor tendon (EDS) at PIP
• Splint entire finger 6-8 weeks

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Common Forearm, Wrist Hand Injuries

• Jersey finger
• Usually a rupture of the flexor digitorum
  profundus
• Gamekeepers thumb
• Sprain of the UCL of thumb

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History

• MOI
• What was the mechanism of injury?
• What were you doing when the injury occurred?
• Did you hear or feel anything at the time of the
  injury?
• Did you receive a direct blow?
• What was the angle of impact?
• What was the position of arm or wrist at impact?
• Was the wrist forced beyond its normal ROM?
• Did you have a violent muscular contraction?
• Were you throwing or swinging?

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History

• S S
• Describe the symptoms.
• Did the pain come on gradually or suddenly?
• Describe the pain.
• Is it sharp or dull?
• Localized or diffuse?
• Any numbness, tingling, or burning?
• Is the pain radiating down your arm?
• Is the pain severe? Does it keep you awake at
  night?
• Demonstrate what causes pain.
• Does the arm feel tight or locked?
• Do you feel any weakness?

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History

• Previous injury
• Have you had a previous injury?
• Did you rehab? If so, what exercises?